Ralph’s Stress Problem

A patient I’ll call Ralph was having a difficult time with Alex, a woman he had been seeing for several years. It’s a familiar story. She didn’t want to make plans for a future together, and he felt frustrated and hopeless. Finally, Ralph came to me because his health was suffering from the stress of the relationship. “The situation with Alex is making me physically ill,” he said. “I can’t sleep, everything I eat upsets my stomach, and I’m so anxious I can’t focus on work or get anything done.”

I suggested he move on, since Alex didn’t sound like a good choice for him. But Ralph refused. I recommended he at least take a break from the relationship, but he shot down that suggestion, too. In fact, he found fault with everything I said. But his resistance told me something important. Ralph was a pessimist. In fact, he had already convinced himself that if he left Alex, he would never find a new companion.

Maybe you know people like Ralph. I call them “Goldilocks” characters. Everything’s too hot or too cold but never just right. You can go out of your way to do something for them, and they’ll find a way to criticize it. Clearly, they are not happy people, but the problem is bigger than that. They tend to make those around them miserable, too. I had a sneaking suspicion that Alex was probably tired of dealing with Ralph if he responded to her the way he did to me.

Finally, I asked Ralph a question that got his attention. “I can give you medication to help your digestion and insomnia, but as long as you’re involved with Alex, none of it is going to work very well. So I have to ask — do you really want to get well? Because I’ve just suggested half a dozen things you can do to get some relief, and all you’ve done is tell me why they won’t work, without even trying any of them.”

Confronting patients who are resistant to the changes required for improving their health can be a risky proposition with lots of potential for backfiring. Fortunately, Ralph was caught off guard by my question and answered truthfully. “I don’t know if I want to get well or not,” he replied. “Sometimes I think Alex only hangs around because she feels sorry for me, since I have so many health problems. She’s probably afraid that if she leaves, I’ll fall apart.”

I explained to Ralph that when he rejects or picks apart solutions people offer him, he makes the other person feel useless. Could that be happening with Alex? Maybe she genuinely likes him but was having a hard time with his pessimistic nature.

To make a long story a bit shorter, Ralph followed my instructions for changing his thinking. He and Alex also went to a couples therapist who helped them improve their communication skills. The last time I saw Ralph, he and Alex were planning a long cruise. “I have to tell you, I’m like a new man. I took your advice and worked really hard on not being a pain in the neck, not just to Alex but to other people, too. And it worked! Alex and I have never been better, and I feel great. I just didn’t realize how downbeat I’d become. But now that I know how to change it, that’ll never happen again.”


Last Updated: August 16, 2018
Originally Published: October 29, 2012